Provider Demographics
NPI:1790275717
Name:MCCORVEY, RAQUEL ANTOINETTE (FNP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANTOINETTE
Last Name:MCCORVEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MARYVIEW FARM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4625
Mailing Address - Country:US
Mailing Address - Phone:337-212-4122
Mailing Address - Fax:
Practice Address - Street 1:850 KALISTE SALOOM RD STE 122
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4230
Practice Address - Country:US
Practice Address - Phone:337-235-9355
Practice Address - Fax:337-235-9356
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily